Biopsy apparatus and method

ABSTRACT

An apparatus and method for the biopsy of tissue specimens and, more particularly, a single insertion multiple sample percutaneous biopsy apparatus and method are provided. A tip at a distal end of a vacuum support tube is introduced into a tissue mass. The vacuum support tube is retracted exposing a basket tube bounded by a front washer and a rear washer mounted thereabout forming a tissue basket. The basket tube is supported internally by a thrust tube which provides structure to the apparatus to allow it to penetrate tissue. The thrust tube and the basket tube are in fluid communication and are provided with suction to draw tissue inward. The tissue is then severed by rotating and advancing a knife edge at the distal end of the vacuum support tube. The tissue basket is withdrawn and the tissue sample is removed by rotating the vacuum support tube. The tissue sample is sliced longitudinally, and a stripper scrapes the tissue sample from an opening in the vacuum support tube.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Application Ser.No. 60/059,547 filed Sep. 19, 1997 by Bryan et al., the entire contentsof which are hereby incorporated by reference.

BACKGROUND

1. Technical Field

This disclosure relates to an apparatus and method for the biopsy oftissue specimens and, more particularly, to a single insertion, multiplesample percutaneous biopsy apparatus and method.

2. Background of Related Art

It is often necessary to sample tissue in order to diagnose and treatpatients suspected of having cancerous tumors, pre-malignant conditionsand other diseases or disorders. Typically, in the case of suspectedcancerous tissue, when the physician establishes by means of proceduressuch as palpation, x-ray or ultrasound imaging that suspiciousconditions exist, a biopsy is performed to determine whether the cellsare cancerous. Biopsy may be done by an open or percutaneous technique.Open biopsy removes the entire mass (excisional biopsy) or a part of themass (incisional biopsy). Percutaneous biopsy on the other hand isusually done with a needle-like instrument and may be either a fineneedle aspiration (FNA) or a core biopsy. In FNA biopsy, individualcells or clusters of cells are obtained for cytologic examination andmay be prepared such as in a Papanicolaou smear. In core biopsy, as theterm suggests, a core or fragment tissue is obtained for histologicexamination which may be done via frozen section or paraffin section. Inmore recent developments percutaneous techniques have been used toremove the entire mass during the initial procedure.

The type of biopsy utilized depends in large part on the circumstancespresent with respect to the patient and no single procedure is ideal forall cases. Core biopsy, however, is extremely useful in a number ofconditions and is being used more frequently.

Intact tissue from the organ or lesion is preferred by medical personnelin order to arrive at a definitive diagnosis regarding the patient'scondition. In most cases only part of the organ or lesion need besampled. The portions of tissue extracted must be indicative of theorgan or lesion as a whole. In the past, to obtain adequate tissue fromorgans or lesions within the body, surgery was performed so as toreliably locate, identify and remove the tissue. With presenttechnology, medical imaging equipment such as stereotactic x-ray,fluoroscopy, computer tomography, ultrasound, nuclear medicine andmagnetic resonance imaging, may be used. These technologies make itpossible to identify small abnormalities even deep within the body.However, definitive tissue characterization still requires obtainingadequate tissue samples to characterize the histology of the organ orlesion.

Mammography can identify non-palpable (not perceptible by touch) breastabnormalities earlier than they can be diagnosed by physicalexamination. Most non-palpable breast abnormalities are benign but someare malignant. When breast cancer is diagnosed before it becomespalpable, breast cancer mortality can be reduced. It is still difficultto determine if pre-palpable breast abnormalities are malignant, as somebenign lesions have mammographic features which mimic malignant lesionsand some malignant lesions have mammographic features which mimic benignlesions. Thus, mammography has its limitations. To reach a definitivediagnosis, tissue from within the breast must be removed and examinedunder a microscope.

The introduction of stereotactic guided percutaneous breast biopsiesoffered alternatives to open surgical breast biopsy. With time, theseguidance systems have become more accurate and easier to use. Biopsyguns were introduced for use in conjunction with these guidance systems.Accurate placement of the biopsy guns was important to obtain usefulbiopsy information because only one small core could be obtained perinsertion at any one location. To sample the lesion thoroughly, manyseparate insertions of the instrument had to be made.

Biopsy procedures may benefit from larger tissue samples being taken,for example, tissue samples as large as 10 mm across. Many of the priorart devices required multiple punctures into the breast or organ inorder to obtain the necessary samples. This practice is both tedious andtime consuming.

One further solution to obtain a larger tissue sample is to utilize adevice capable of taking multiple tissue samples with a single insertionof an instrument. An example of such a device is found in U.S. Pat. No.5,195,533 to Chin et al. which describes a technique for extractingmultiple samples with a single insertion of the biopsy device.Generally, such biopsy instruments extract a sample of tissue from atissue mass by either drawing a tissue sample into a hollow needle viaan external vacuum source or by severing and containing a tissue samplewithin a notch formed on a stylet. Typical of such devices utilizing anexternal vacuum source are U.S. Pat. No. 5,246,011 issued to Cailouetteand U.S. Pat. No. 5,183,052 issued to Terwiliger. Such devices generallycontemplate advancing a hollow needle into a tissue mass and applying avacuum force to draw a sample into the needle and hold the same thereinwhile the tissue is extracted.

When extracting multiple samples with a single insertion of the biopsydevice using suction to either draw in tissue or remove the tissue fromthe body, it is important that the vacuum path remain unclogged. If thevacuum path clogs, the sample removal will become difficult orimpossible. This may necessitate multiple insertions of the device orreduce the sample mass per extraction.

Therefore, a continuing need exists for percutaneous biopsy apparatusand methods which can reliably extract adequate biopsy sample(s) with asingle insertion of the biopsy instrument.

SUMMARY

The present disclosure describes an apparatus and method for the biopsyof tissue specimens and, more particularly, to a single insertionmultiple sample percutaneous biopsy apparatus and method. A tip at adistal end of a vacuum support tube is introduced into a tissue mass.The vacuum support tube is retracted exposing a basket tube bounded by afront washer and a rear washer mounted thereabout forming a tissuebasket. The basket tube is supported internally by a thrust tube whichprovides structure to the apparatus to allow it to penetrate tissue. Thethrust tube and the basket tube are in fluid communication and areprovided with suction to draw tissue inward. The tissue is then severedby rotating and advancing a knife edge at the distal end of the vacuumsupport tube. The tissue basket is withdrawn and the tissue sample isremoved by rotating the vacuum support tube. The tissue sample is slicedlongitudinally, and a stripper scrapes the tissue sample from an openingin the vacuum support tube.

The surgical biopsy apparatus disclosed includes a base portion having aproximal and a distal end. Desirably, the base portion further comprisesa nose support, a center support and a back support.

The apparatus further includes a first elongated tubular member having aproximal and a distal end and is removably supported in the base portionand further defines a fluid passageway. The proximal end of the firstelongated member is supported at the proximal end of the base portion.The first elongated tubular member includes a tip portion disposed atits distal end and adapted to penetrate tissue and a plurality ofopenings formed adjacent its distal end and in fluid communication withthe fluid passageway. Preferably, the distal end of the first elongatedtubular member is supported at the back support of the base portion.

Most preferably, the tip has a tapered closed distal end and a steppedproximal end configured to cooperatively engage the distal end of thefirst elongated tubular member.

A suction junction is fixedly supported at the proximal end of the baseportion and removably mounted to the proximal end of the first elongatedtubular member and in fluid communication therewith.

The apparatus also includes a second elongated tubular member having aproximal and a distal end and is reciprocatingly disposed coaxiallyabout the first elongated tubular member and is movable from a retractedposition to an extended position. The distal end of the second elongatedtubular member is disposed laterally adjacent to the plurality ofopenings of the first elongated member and supported at the proximal endof the base portion. The second elongated tubular member defines atissue receiving portion disposed adjacent to its distal end and furtherdefines a plurality of openings in fluid communication with theplurality of openings of the first elongated member. Preferably, thesecond elongated tubular member is supported at the back support of thebase portion.

A third elongated tubular member is included having a proximal and anopen distal end and is slidably mounted to the base portion androtatably and reciprocatingly disposed coaxially about the first andsecond elongated tubular members. The third elongated tubular memberincludes a cutting edge formed at the open distal end and a lateraltissue discharge port. The third elongated tubular member is movablefrom an extended position wherein the cutting edge is disposed adjacentthe tip portion of the first elongated tubular member and a retractedposition wherein the lateral tissue discharge port is disposed laterallyadjacent the tissue receiving portion of the second elongated tubularmember. A vacuum port assembly is fixedly mounted to the proximal end ofthe second elongated tubular member and in fluid communicationtherewith. Preferably, a control member mounted to its proximal end.Most preferably, the control member has a circular configuration anddefines a knurled outer peripheral surface.

In a preferred embodiment, the apparatus includes a latch plate assemblyattached to the base portion between the center and back supports. Thelatch plate assembly includes a first latch having a cantileveredportion and a camming surface resiliently biased against the controlmember. The cantilevered portion releasably locks the third elongatedtubular member at its distalmost position.

In another preferred embodiment, the latch plate assembly furthercomprises a second latch having a cantilevered portion and a cammingsurface resiliently biased against the vacuum port assembly. Thecantilevered portion releasably locks the vacuum port assembly at itsdistalmost position.

In yet another preferred embodiment, the second elongated tubular memberdefines a fluid passageway in fluid communication with the vacuum portassembly. Preferably, the second elongated tubular member furtherincludes a front washer and a rear washer that define the tissuereceiving portion therebetween. The rear washer further defines aplurality of transverse openings spaced radially thereabout in fluidcommunication with the fluid passageway of the second elongated tubularmember.

In one particular embodiment, a cutting element is longitudinallyattached to an exterior surface of the first elongated tubular memberand positioned to sever a tissue sample. Preferably, the secondelongated tubular member defines a slot for receiving the cuttingelement.

In another embodiment, the apparatus comprises a tissue stripping membermounted to the base portion and disposed between the nose support andthe center support. The tissue stripping member includes a flexibleextended portion configured and dimensioned to enter the tissuedischarge port of the third elongated tubular member upon alignment ofthe tissue discharge port with the tissue receiving portion of thesecond elongated tubular member. Preferably, the tissue stripping memberincludes a friction reducing coating formed thereon to reduce frictionwith body tissue coming in contact with the tissue stripping member.

A method of performing a surgical biopsy is disclosed comprising thesteps of: inserting a biopsy apparatus into the tissue of a patient, thebiopsy apparatus including: a first elongated tubular member defining afluid passageway and having a tip portion at the distal end forpenetrating tissue and further defining a plurality of openings formedadjacent the distal end and in fluid communication therewith, a secondelongated tubular member defining a tissue receiving portion and aplurality of openings in fluid communication with the plurality ofopenings of the first elongated tubular member, and a third elongatedtubular member having a cutting edge formed at an open distal end anddefining a lateral tissue discharge port, extending the second elongatedtubular member to align the plurality of openings of the first elongatedtubular member and the plurality of openings of the second elongatedtubular member, retracting the third elongated tubular member to exposethe tissue receiving portion of the second elongated tubular member,applying suction to the fluid passageway of the first elongated tubularmember in fluid communication with the plurality of openings of thefirst elongated tubular member and thereby in fluid communication withthe plurality of openings of the second elongated tubular member to pulltissue into the tissue receiving portion, severing tissue disposedwithin the tissue receiving portion by extending the third elongatedtubular member to adjacent the closed distal tapered end portion of thefirst elongated tubular member such that a cutting surface formed on theopen distal end of the third elongated tubular member rotates as itpasses over the tissue receiving portion, and removing the severedtissue sample from the tissue sampling site by applying suction to afluid passageway defined in the second elongated tubular member in fluidcommunication with a plurality of openings defined within a rear washerof the second elongated tubular member, retracting the second elongatedtubular member and thereby pulling the severed tissue sample until thetissue receiving portion is aligned with the lateral discharge port ofthe third elongated tubular member wherein a tissue stripping plateurges the tissue sample out of the tissue receiving portion.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments are described herein with reference to the drawings,wherein:

FIG. 1 is a perspective view of a biopsy apparatus;

FIG. 2 is an exploded perspective view of the biopsy apparatus of FIG.1;

FIG. 3 is a perspective view of an area of detail indicated in FIG. 2;

FIG. 4 is a perspective view of an area of detail as indicated in FIG.2;

FIG. 5 is an exploded perspective view of a cutting tube;

FIG. 6 is an exploded perspective view of a thrust tube and a razorblade;

FIG. 7 is an enlarged view of the razor blade of FIG. 6;

FIG. 8 is an exploded perspective view of a basket tube and a vacuumport;

FIG. 9 is a rotated exploded perspective view of the basket tube and thevacuum port of FIG. 8;

FIG. 10 is an exploded perspective view of a base with supports and alatch plate;

FIG. 11 is a cross sectional view of the biopsy apparatus of FIG. 1;

FIG. 12 is a cross-sectional view of an area of detail indicated in FIG.11;

FIG. 13 is a cross-sectional view of an area of detail indicated in FIG.11;

FIG. 14 is an enlarged perspective view of a tip portion of the biopsyapparatus of FIG. 1 with the cutting tube broken away;

FIG. 15 is an enlarged perspective view of a tip portion of the biopsyapparatus of FIG. 1 with the cutting tube and the basket tube brokenaway;

FIG. 16 is a side view of the biopsy apparatus of FIG. 1 prior toinsertion into a breast;

FIG. 17 is a side view of the biopsy apparatus of FIG. 1 after insertioninto the breast;

FIG. 18 is a cross sectional view of the biopsy apparatus of FIG. 1showing the cutting tube retracted to accept a tissue sample;

FIG. 19 is a cross-sectional view of an area of detail indicated in FIG.18;

FIG. 20 is a cross-sectional view of the area of detail indicated inFIG. 18 showing the cutting tube advanced and rotated;

FIG. 21 is a perspective view showing a tissue sample severed anddisposed in a basket portion;

FIG. 22 is a perspective view showing a tissue sample being slicedlongitudinally;

FIG. 23 is a cross-sectional view of the biopsy apparatus of FIG. 1showing the tissue sample ready to be removed from the cutting tube;

FIG. 24 is a cross-sectional view of an area of detail indicated in FIG.23;

FIG. 25 is a cross-sectional view taken along section line 25--25 ofFIG. 24;

FIG. 26 is a cross-sectional view showing forceps removing the tissuesample;

FIG. 27 is a cross-sectional view showing a stripping plate removing thetissue sample;

FIG. 28 is a perspective view of a biopsy apparatus having a strippingplate attached thereto;

FIG. 29 is a perspective view of a basket converter;

FIG. 30 is an enlarged perspective view of a tip portion showing abasket converter mounted therein; and

FIG. 31 is a cross-sectional view taken along section lines 31--31 ofFIG. 30.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Referring now in specific detail to the drawings, in which likereference numerals identify similar or identical elements throughout theseveral views, and initially to FIG. 1, a biopsy apparatus constructedin accordance with the present disclosure is shown generally as biopsyapparatus 10. Biopsy apparatus 10 includes an insertion portion 12 and abase portion 14.

Referring to FIGS. 2, 3 and 4, a tip 13 is rigidly mounted to distal end15 of a thrust tube 16. Thrust tube 16 is disposed in a basket tube 18which slides longitudinally along thrust tube 16. Basket tube 18 has afront washer 20 and a rear washer 22 mounted thereon. Front washer 20and rear washer 22 are spaced a predetermined distance apart bounding abasket portion 19 of basket tube 18.

Basket portion 19 has a smaller diameter than basket tube 18. Basketportion 19, front washer 20 and rear washer 22 are dimensioned to fitwithin a cutting tube 24 and form a tissue basket 27 for receivingtissue therein. Basket portion 19 has a plurality of holes 114 providedtherethrough in order to be able to communicate with suction providedthrough thrust tube 16 during operation. A vacuum port 28 attaches to aproximal end of basket tube 18 for providing an attachment to a vacuumsource (not shown). A razor blade 106 is longitudinally attached to anexterior surface 108 of thrust tube 16 and extends therefrom in aradially outward direction. A suction knob 66 is shown for attaching toa proximal end of thrust tube 16.

Turning now to FIG. 5, a knob 44 is rigidly mounted to a proximal end 46of cutting tube 24. Knob 44 is used to rotate cutting tube 24. Thesurface of knob 44 can be knurled to improve grip when rotating cuttingtube 24. A distal end 48 of cutting tube 24 is stone ground to form asharpened edge 50 thereabout. Distal end 48 receives a stepped portion52 of tip 13 of thrust tube 16 (FIG. 6). Distal end 48 and steppedportion 52 (FIG. 6) are dimensioned to provide a shearing actiontherebetween. Cutting tube 24 has an opening 102 located thereon forretrieving tissue samples from therein.

Referring to FIGS. 6 and 7, thrust tube 16 has a plurality of holes 112near distal end 15. Distal end 15 of thrust tube 16 is rigidly attachedto tip 13. Razor blade 106 attaches to thrust tube 16 by brazing,welding or other compatible process. A leading edge 109 of razor blade106 can be placed proximally to plurality of holes 112 in thrust tube 16to place razor blade 106 in a position to cut a tissue sample whenbasket portion 19 is retracted. A tab 107 is formed on a distal endportion 113 of razor blade 106.

Referring to FIGS. 8 and 9, vacuum port 28 defines a suction port 32, abasket tube port 34 and a through hole 36 for thrust tube 16. Suctionport 32, basket tube port 34 and through hole 36 fluidly communicatewithin vacuum port 28. Basket tube 18 has a proximal end 26 which isrigidly mounted within basket tube port 34. Basket tube 18 fluidlycommunicates with vacuum port 28 through a hole 29 formed on basket tube18. Vacuum port 28 is connected to a vacuum source (not shown) by afitting 31 which connects to suction port 32. An O-ring cap 40 of vacuumport 28 is removable to aid in assembly of basket tube 18. An O-ring 38is supported by O-ring cap 40 which has a bore 41 therein to prevent airleakage between O-ring cap 40 and vacuum port 28. O-ring 38 is preloadedand secured by O-ring cap 40 which is attached to vacuum port 28 therebycompressing O-ring 38 therebetween.

FIG. 10 illustrates base portion 14 of FIG. 1. Cutting tube 24 (FIG. 2)is supported by a nose support 54 and a center support 56 through bores55. Nose support 54 and center support 56 allow axial translation androtation of cutting tube 24. Nose support 54 is attached at a distal end58 of a base 60 and center support 56 is spaced apart and mounted tobase 60 at a predetermined distance from nose support 54. Base 60 has aback support 62 attached at a proximal end 64. Back support 62 has abore 63 therethrough which receives suction knob 66 (FIG. 2) therein.Suction knob 66 is rigidly mounted on a proximal end 68 of thrust tube16 (FIG. 2). A latch plate 72 is attached to base 60 between backsupport 62 and center support 56.

Referring to FIGS. 11 and 12, latch plate 72 has a distal end portion 74having a first latch 76 cantilevered therefrom. First latch 76 has acamming surface 78 thereon which has a high point 80 distally disposed.Latch plate 72 has a proximal end portion 88 with a second latch 90cantilevered therefrom. Second latch 90 has a camming surface 92 thereonwhich has a high point 94 distally disposed. Vacuum port 28 and knob 44are shown in their distalmost positions. Suction knob 66 is disposed inbore 63 of back support.

Referring to FIG. 12, knob 44 (as seen in FIG. 11) in its distal mostposition corresponds to tissue basket portion 19 being fully enclosedwithin cutting tube 24. Edge 50 of cutting tube 24 receives steppedportion 52 of tip 13. Rear washer 22 is disposed within the distal endof basket tube 18. Basket tube 18, front washer 20 and rear washer 22are dimensioned and configured to fit within cutting tube 24. An annularregion 21 is formed between cutting tube 24 and basket portion 19.Thrust tube 16 is disposed within basket tube 18 such that plurality ofholes 114 in basket tube 18 are substantially aligned with plurality ofholes 112 in thrust tube 16 and holes 114 and holes 112 fluidlycommunicate with annular region 21.

Referring to FIG. 13, opening 102 in cutting tube 24 is closed by baskettube 18 when vacuum port 28 (FIG. 11) is fully advanced distally. Razorblade 106 is shown in phantom dispose on thrust tube 16.

Referring to FIGS. 14 and 15, razor blade 106 is dimensioned to fitinside cutting tube 24. Basket tube 18 has a slit 111 which allows tab107 of razor blade 106 to fit therethrough. A longitudinal slot 110continues through front washer 20 (in phantom), basket portion 19 andrear washer 22. Razor blade 106 prevents relative rotation betweenthrust tube 16 and basket tube 18. Rear washer 22 has a plurality ofholes 116 therethrough for fluidly communicating between basket portion19 and basket tube 18 when disposed within cutting tube 24.

Referring to FIGS. 16 and 17, during a biopsy procedure a patient'sbreast 140 is disposed between a movable clamp 142 and a stationaryclamp 144. Movable clamp 142 is moved toward stationary clamp 144capturing breast 140 therebetween. Upon securing breast 140 in positiona guidance system (not shown) locates a target tissue mass 146 withinbreast 140. Assembly 10 is aimed at target tissue mass 146 such thatinsertion portion 12 is aligned with the direction of advancement ofbase portion 14. Stationary clamp 144 defines an opening 148therethrough to allow insertion portion 12 to enter breast 140. Beforeinsertion into breast 140, vacuum port 28 and cutting tube 24 are fullyadvanced distally to locate tissue basket 19 adjacent to tip 13 and toenclose basket portion 19, respectively, as shown in FIGS. 11 and 12.Knob 44 is secured by first latch 76 in the distalmost position of knob44. A nick at the point of insertion of tip 13 is desirable for easyentry into breast 140. Tip 13 is inserted at the location of the nickinto breast 140. Guidance systems are employed for determining thelocation of tip 13 inside the patient's body, and typically includex-rays and stereotactic devices. Insertion portion 12 is advanceddistally into breast 140 until basket portion 19 is located adjacent toor within target tissue mass 146 as desired.

Referring to FIGS. 18 and 19, front washer 20 of basket portion 19 isheld in contact with tip 13 inside cutting tube 24. Vacuum port 28 is inits distalmost position and secured in place by second latch 90. Firstlatch 76 is deflected in the direction of arrow "A" by pressing down onfirst latch 76, thereby releasing knob 44 and allowing knob to moveproximally. Cutting tube 24 is retracted by moving knob 44 proximally,thereby exposing tissue basket 19 to target tissue mass 146.

Suction is applied through thrust tube 16 which is communicated throughplurality of holes 112 at distal end 15. Plurality of holes 112 atdistal end 15 of thrust tube 16 communicate with plurality of holes 114in basket portion 19. Suction draws target tissue mass 146 into tissuebasket 19 circumferentially about tissue basket 19. Target tissue mass146 is now prepared for severing.

When a predetermined period of time has elapsed suction is applied tovacuum port 28 as well. Vacuum port 28 communicates with basket tube 18which communicates with plurality of holes 116 through rear washer 22.This draws target tissue mass 146 against rear washer 22 and secures thetissue mass thereto.

Referring to FIGS. 20 and 21, knob 44 is used to translate and rotatecutting tube 24 simultaneously. Knob 44 is translated distally to allowedge 50 of cutting tube 24 to sever a tissue sample 150 from targettissue mass 146. Knob 44 is rotated and advanced distally in asimultaneous motion to sever target tissue mass 146 about tissue basket19. Target tissue mass 146 is cut with edge 50 of cutting tube 24 toform an annular tissue sample 150. Knob 44 moves up camming surface 78of first latch 76 as knob 44 is advanced and finally knob 44 is lockedin its distalmost position by first latch 76. The distalmost position ofknob 44 corresponds with edge 50 engaging stepped portion 52 of tip 13completing the severing of tissue sample 150 and closing off tissuebasket 19. As cutting tube 24 severs tissue sample 150, suction throughbasket tube 18 and rear washer 22 provides an opposing force against thedistal motion of cutting tube 24 to allow tissue sample 150 to besevered. First latch 76 secures knob 44 and cutting tube 24 in thedistalmost position. When edge 50 of cutting tube 24 has reached tip 13,tissue sample 150 is severed and may be removed from breast 140.

Referring to FIGS. 22 and 23, after tissue sample 150 is severed,suction may be removed from thrust tube 16. Second latch 90 is deflectedin the direction of arrow "B" by pressing down on second latch 90,thereby releasing vacuum port 28 and allowing vacuum port 28 to be movedproximally. With suction maintained on basket tube 18 through vacuumport 28, vacuum port 28 is moved proximally thereby retracting baskettube 18 and tissue basket 19. As basket tube 18 and tissue basket 19 areretracted, razor blade 106, disposed within slot 110, slices tissuesample 150 longitudinally. Suction through plurality of holes 116 inrear washer 22 provides an opposing force to allow tissue sample 150 tobe sliced.

Referring to FIGS. 24, 25 and 26, tissue sample 150 may be accessed forremoval through opening 102. Razor blade 106 has provided tissue sample150 with a longitudinal slit to allow tissue sample 150 to be peeledfrom basket portion 19.

During tissue sample 150 removal, tip 13 and cutting tube 24 remainadjacent to tissue mass 146. Upon removal of a first tissue sample 150,for example by forcep: tissue basket 19 may be reintroduced adjacent totip 13 within the patient's body. Cutting tube 24 is retracted to acceptmore tissue mass 146 and the process as described hereinabove isrepeated until enough tissue samples are collected or the targetedtissue mass 120 is removed, as necessary. A single insertion of biopsyapparatus 10 can therefore remove multiple tissue samples.

Referring to FIG. 27, a stripper plate 200 is mounted to base 60 betweennose support 54 and center support 56. Opening 102 of cutting tube 24 isdisposed between nose support 54 and center support 56 when knob 44 isin its distalmost position. Opening 102 corresponds to a strippingsurface 204 on stripper plate 200 which also aligns with basket portion19 such that tissue samples may be removed when basket portion 19 isrotated by turning thrust tube 16. Basket portion 19 is aligned withopening 102 and stripper plate 200 when vacuum port 28 and thereforebasket tube 18 are in a proximalmost position.

Suction is removed from thrust tube 16 and vacuum port 28. Strippingplate 200 acts as a spring and enters opening 102 when tissue basket 19,with its reduced diameter, is adjacent thereto.

Referring to FIGS. 29, 30 and 31, a basket converter 130 may beintroduced into basket portion 19. Basket converter 130 is a hollowcylinder defining an open longitudinal potion 132. Open longitudinalportion 132 can be a section between 10 and 130 degrees about the basketconverter 130, preferably 120 degrees. Basket converter 130 snaps overbasket portion 19 to reduce the exposed area of basket portion 19. Thisserves to concentrate tissue mass removal to a more specific location.Tissue sampling is performed as mentioned above, however, openlongitudinal portion 132 must not interfere with slot 110 and razorblade 106. Open longitudinal portion 132 must therefore be positionedover slot 110 in basket portion 19. Further an outside diameter 134 ofbasket converter 130 must be dimensioned to fit inside cutting tube 24.

It will be understood that various modifications may be made to theembodiments disclosed herein. For example, basket converter 130 may havedifferent size openings therein to allow for more specialized tissuesampling. Therefore, the above description should not be construed aslimiting, but merely as exemplifications of preferred embodiments.

What is claimed is:
 1. A surgical biopsy apparatus, comprising:a baseportion having a proximal and a distal end; a first elongated tubularmember having a proximal and a distal end and defining a fluidpassageway therein, the proximal end of the first elongated member beingslidably supported at the proximal end of the base portion and extendinglongitudinally therefrom, the first elongated tubular member furtherincluding:a tip portion disposed at its distal end and adapted topenetrate tissue; a plurality of openings formed adjacent its distal endand in fluid communication with the fluid passageway; a second elongatedtubular member having a proximal and a distal end and reciprocatinglydisposed coaxially about the first elongated tubular member and beingmovable from a retracted position to an extended position wherein thedistal end of the second elongated member is disposed laterally adjacentthe plurality of openings of the first elongated member, the proximalend of the second elongated member being slidably supported at theproximal end of the base portion, the second elongated tubular memberdefining a tissue receiving portion disposed adjacent its distal end,the tissue receiving portion defining a plurality of openings in fluidcommunication with the plurality of openings of the first elongatedmember; a third elongated tubular member having a proximal and an opendistal end and slidably mounted to the base portion and rotatably andreciprocatingly disposed coaxially about the first and second members,the third elongated tubular member including: a cutting edge formed atthe open distal end; and a lateral tissue discharge port, the thirdelongated tubular member being movable from an extended position whereinthe cutting edge is disposed adjacent the tip portion of the firstelongated tubular member and a retracted position wherein the lateraltissue discharge port is disposed laterally adjacent the tissuereceiving portion of the second elongated tubular member.
 2. Thesurgical biopsy apparatus according to claim 1, further comprising asuction junction fixedly supported at the proximal end of the baseportion, the suction junction removably mounted to the proximal end ofthe first elongated tubular member and in fluid communication therewith.3. The surgical biopsy apparatus according to claim 1, further includinga vacuum port assembly fixedly mounted to the proximal end of the secondelongated tubular member and in fluid communication therewith.
 4. Thesurgical biopsy apparatus according to claim 3, wherein the thirdelongated tubular member further comprises a control member mounted toits proximal end.
 5. The surgical biopsy apparatus according to claim 4,wherein the control member has a circular configuration and defines aknurled outer peripheral surface.
 6. The surgical biopsy apparatusaccording to claim 4, wherein the base portion further comprises a nosesupport, a center support and a back support.
 7. The surgical biopsyapparatus according to claim 6, further including a latch plate assemblyattached to the base portion between the center and back supports, thelatch plate assembly including a first latch having a cantileveredportion and a camming surface resiliently biased against the controlmember, the cantilevered portion releasably locking the third elongatedtubular member at its distalmost position.
 8. The surgical biopsyapparatus according to claim 7, wherein the latch plate assembly furthercomprises a second latch having a cantilevered portion and a cammingsurface resiliently biased against the vacuum port assembly, thecantilevered portion releasably locking the vacuum port assembly at itsdistalmost position.
 9. The surgical biopsy apparatus according to claim6, wherein the distal end of the first elongated tubular member issupported at the back support of the base portion.
 10. The surgicalbiopsy apparatus according to claim 6, wherein the second elongatedtubular member is supported at the back support of the base portion. 11.The surgical biopsy apparatus according to claim 6, further comprising atissue stripping member mounted to the base portion and disposed betweenthe nose support and the center support, the tissue stripping memberincluding a flexible extended portion configured and dimensioned toenter the tissue discharge port of the third elongated tubular memberupon alignment of the tissue discharge port with the tissue receivingportion of the second elongated tubular member.
 12. The surgical biopsyapparatus according to claim 11, wherein the tissue stripping memberincludes a friction reducing coating formed thereon to reduce frictionwith body tissue coming in contact with the tissue stripping member. 13.The surgical biopsy apparatus according to claim 3, wherein the secondelongated tubular member defines a fluid passageway in fluidcommunication with the vacuum port assembly.
 14. The surgical biopsyapparatus according to claim 14, wherein the second elongated tubularmember further includes a front washer and a rear washer mounted thereonand defining the tissue receiving portion therebetween, the rear washerdefining a plurality of transverse openings spaced radially thereaboutin fluid communication with the fluid passageway of the second elongatedtubular member.
 15. The surgical biopsy apparatus according to claim 1,wherein the tip has a tapered closed distal end and a stepped proximalend configured to cooperatively engage the distal end of the firstelongated tubular member.
 16. The surgical biopsy apparatus according toclaim 1, wherein a cutting element is longitudinally attached to anexterior surface of the first elongated tubular member, the cuttingelement positioned to sever a tissue sample.
 17. The surgical biopsyapparatus according to claim 16, wherein the second elongated tubularmember defines a slot for receiving the cutting element.
 18. A surgicalbiopsy apparatus, comprising:a base portion having a proximal and adistal end, the base portion further including a nose support, a centersupport and a back support; a latch plate assembly attached to the baseportion between the center and back supports, the latch plate assemblyincluding a first latch and a second latch wherein each latch has acantilevered portion and a camming surface; a first elongated tubularmember having a proximal and a distal end and removably supported in thebase portion and defining a fluid passageway therein, wherein theproximal end of the first elongated member is supported by the backsupport of the base portion, the first elongated tubular memberincluding: a tapered closed distal end portion adapted to penetratetissue; a plurality of openings formed adjacent its distal end and influid communication with the fluid passageway; a cutting elementlongitudinally attached to an exterior surface of the first elongatedmember and extending radially outward therefrom; a suction junction isfixedly supported within the back support of the base portion, thesuction junction removably mounted to the proximal end of the firstelongated tubular member and in fluid communication therewith; a secondelongated tubular member having a proximal and a distal end andreciprocatingly disposed coaxially about the first elongated tubularmember and being movable from a retracted position to an extendedposition wherein the distal end of the second elongated member isdisposed laterally adjacent the plurality of openings of the firstelongated member, wherein the distal end of the second elongated memberis supported by the back support of the base portion, the secondelongated tubular member including: a front washer and a rear washermounted thereon and defining a tissue receiving portion therebetween,the rear washer defining a plurality of openings disposed radiallythereabout and the tissue receiving portion defining a plurality ofopenings in fluid communication with the plurality of openings of thefirst elongated member; a third elongated tubular member having aproximal and an open distal end and slidably mounted in the base portionand rotatably and reciprocatingly disposed coaxially about the first andsecond members, the third elongated tubular member including: a cuttingedge formed at the open distal end; a lateral tissue discharge port, thethird elongated tubular member being movable from an extended positionwherein the cutting edge is disposed adjacent the tapered closed distalend portion of the first elongated tubular member and a retractedposition wherein the lateral tissue discharge port is disposed laterallyadjacent the tissue receiving portion of the second elongated tubularmember; and a vacuum port assembly fixedly mounted to the proximal endof the second elongated tubular member and in fluid communicationtherewith.
 19. A method of performing a surgical biopsy comprising thesteps of:inserting a biopsy apparatus into the tissue of a patient, thebiopsy apparatus including: a first elongated tubular member defining afluid passageway therein and further defining a plurality of openingsformed adjacent a distal end and in fluid communication with the fluidpassageway, a second elongated tubular member defining a tissuereceiving portion and a plurality of openings in fluid communicationwith the plurality of openings of the first elongated tubular member,and a third elongated tubular member having a cutting edge formed at anopen distal end and defining a lateral tissue discharge port; extendingthe second elongated tubular member to align the plurality of openingsof the first elongated tubular member and the plurality of openings ofthe second elongated tubular member; retracting the third elongatedtubular member to expose the tissue receiving portion of the secondelongated tubular member; applying suction to the fluid passageway ofthe first elongated tubular member in fluid communication with theplurality of openings of the first elongated tubular member and therebyin fluid communication with the plurality of openings of the secondelongated tubular member, to pull tissue into the tissue receivingportion; severing tissue disposed within the tissue receiving portion byextending the third elongated tubular member to adjacent a closed distaltapered end portion of the first elongated tubular member, such that acutting surface formed on the open distal end of the third elongatedtubular member rotates as it passes over the tissue receiving portion;and removing the severed tissue sample from the tissue sampling site byapplying suction to a fluid passageway defined in the second elongatedtubular member in fluid communication with a plurality of openingsdefined within a rear washer of the second elongated tubular member,retracting the second elongated tubular member and thereby pulling thesevered tissue sample until the tissue receiving portion is aligned withthe lateral discharge port of the third elongated tubular member whereina tissue stripping plate urges the tissue sample out of the tissuereceiving portion.